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TRICARE Policy Manual 6010.60-M, April 1, 2015
Extended Care Health Option (ECHO)
Chapter 9
Section 16.1
Cost-Share Liability
Issue Date:  December 16, 1985
Authority:  32 CFR 199.5(f)
Revision:  C-27, July 26, 2018
1.0  POLICY
1.1  Extended Care Health Option (ECHO) allowable amounts are not subject to a deductible amount.
1.2  The sponsor/beneficiary ECHO cost-share for every month in which ECHO benefits, including the ECHO Home Health Care (EHHC) benefits, are received is according to the sponsor’s pay grade as specified below, regardless of the number of dependents of that same sponsor receiving ECHO benefits in that month:
ECHO Cost-Share Amounts
Sponsor Pay Grade Code
Sponsor Cost-Share Amount
E-1 through E-5
$25
E-6
30
E-7 and O-1
35
E-8 and O-2
40
E-9, WO/WO-1, CWO-2, and O-3
45
CWO-3, CWO-4, and O-4
50
CWO-5, O-5
65
O-6
75
O-7
100
O-8
150
O-9
200
O-10
250
1.3  The sponsor/beneficiary is responsible for the appropriate amount shown in the above table plus any amount in excess of the Government’s maximum coverage for any benefits received in an enrollment (calendar beginning 2019; see paragraph 1.9) year, including the 90 day period the beneficiary is given “provisional” status.
1.4  The sponsor/beneficiary cost-shares under the ECHO are in addition to those incurred for services and items received through the TRICARE plan options.
1.5  The sponsor/beneficiary cost-shares under the ECHO do not accrue to meeting the catastrophic cap in the TRICARE Basic Program.
1.6  The sponsor/beneficiary cost-shares in the above table that are applicable for ECHO benefits, other than EHHC services, do not accrue to the EHHC benefit cap.
1.7  The Government’s maximum annual year cost-share for ECHO benefits applies to each beneficiary, regardless of the number of dependents with the same sponsor receiving ECHO benefits in that year.
1.8  The allowed cost of all services provided by this chapter, except the EHHC, through December 31, 2018, accrue to the Government’s maximum fiscal year cost-share of $36,000. The contractor shall prorate the $36,000 cap for the last quarter of CY 2018 (i.e., $9,000 max) per new 32 CFR 199.5(a)(3) to transition the regulation from FY to CY.
1.9  The allowed cost of all services provided by this chapter, except the EHHC, on or after January 1, 2019, accrue to the Government’s maximum calendar year cost-share of $36,000.
1.10  For services received prior to January 1, 2019, deductibles and catastrophic loss protection are applicable on a fiscal year basis. For services received on or after January 1, 2018, deductibles and catastrophic loss protection are applicable on a calendar year basis.
1.11  In order to transition deductibles and catastrophic loss protection from a fiscal year to a calendar basis, the deductible and catastrophic loss protection amounts for FY 2018 will be applicable to services received during the 15 month period of October 1, 2017, through December 31, 2018.
1.12  The Government’s maximum annual cost-share for the EHHC benefit is as calculated in Section 15.1.
2.0  EFFECTIVE DATE
September 1, 2005.
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